Ketorolac (Ophthalmic)

This ophthalmic medicine is delivered directly to the eyes when swelling occurs after cataract surgery, or when eyes are irritated due to seasonal allergies.

Overview

Belonging to the class of drugs called non-steroidal anti-inflammatory drugs (NSAIDs), ketorolac is often used to manage swelling which occurs in the eyes after certain types of eye surgery. It is also used to help control the symptoms which may flare up during seasonal allergies, at least those which are specific to the eyes, such as a watery condition, swelling, itching, redness and general irritation.

Ketorolac works by blocking or lowering the production of hormones produced naturally in the body, which are responsible for causing pain and inflammation around the eyes. Since it comes in liquid form, it can easily be delivered to the eye area by using an eye dropper, and for the treatment of allergies, a patient would typically administer a single drop, four times each day to keep symptoms under control. This would probably be necessary throughout the entire allergy season, or until the patient was no longer exposed to those substances which triggered the allergy.

Condition Treated

  • Seasonal allergy symptoms
  • Eye swelling after cataract surgery

Type Of Medicine

  • Non-steroidal anti-inflammatory drugs

Side Effects

While ketorolac provides some very powerful benefits to patients who suffer from seasonal allergies, or who have had some kind of eye surgery, there may also be some unwanted side effects which become apparent after using the medication. For the most part, any side effects reported by patients using this medicine have been fairly mild in nature, and have not occurred with great frequency, but it is still advisable to be aware of the potential for at least some side effects when using this medicine.

In extremely rare cases, some patients have discovered that they were allergic to ketorolac, either mildly or moderately. A severe allergic reaction to it is also possible, and if this should occur in your case, you should seek medical attention at the earliest opportunity, since the symptoms which arise can be life-threatening. The symptoms which you should look for if you think you are having an allergic reaction to this medication are as follows:

  • Severe itchiness at various sites around the body
  • Difficulty breathing, usually with noticeable tightness in the chest
  • The appearance of hives and/or rashes on the skin
  • Severe puffiness or swelling of the eyelids, lips, tongue, or throat
  • Dizziness or lightheadedness, with the sensation that you are about to faint.

Some much milder side effects can occur for users of this medication, including those in the list below:

  • Tearing of the eyes
  • Itching, redness or other eye irritations, which gradually become worse
  • Light sensitivity
  • Swelling all around the eyes
  • Throbbing pain centered around the eyes
  • Blurry vision or other changes to your vision
  • Stinging or burning sensation as the medicine is applied
  • Headaches
  • Dry eyes

There are some other minor side effects which are extremely random and infrequent in occurrence, since they come and go quickly. These do not require any kind of medical attention, and really only occur as your body is adjusting to the new medication you are using. If any of the other side effects listed above become uncomfortable for you, you should contact your doctor and describe the type of side effects which you are experiencing, as well as the severity of them. This may cause your doctor to consider other treatment alternatives, or to reduce your dosage of ketorolac.

Dosage

It is permissible to use ketorolac with other ophthalmic medications, but you should wait five minutes or more before administering any other eye medicine to the same eye. As this medicine is being administered to the eyes, you should take out contact lenses if you are wearing them, and then leave them out for a few minutes afterward.

For patients who are using ketorolac as a follow-up to eye surgery, a single bottle per each eye is recommended, rather than using the same bottle for both eyes. The procedure you should use when delivering this medicine to your eyes is as follows:

  • Wash both hands with warm water and soap
  • Tilt your head backward
  • Use one finger to gently press against the lower eyelid and pull it downward away from the eye
  • Use an eyedropper to deliver the medicine into the space vacated by the lower eyelid
  • Release the lower eyelid and close your eyes, but do not blink
  • Keep your eyes closed for approximately two minutes, so that the medicine has a chance to be fully absorbed by your eyes
  • When you are completely finished, wash your hands again thoroughly so that you are sure to remove any medication which may have gotten on them
  • If you don't think that the drop of medicine was actually delivered correctly to the eye, repeat the procedure above
  • As you establish your eye dropping routine daily, make sure to keep the tip of the eyedropper away from any other surfaces (including the eyes), so that it does not have an opportunity to come in contact with germs
  • Keep the container of your eyedrop solution close tightly at all times.

Dosing for patients using ketorolac will probably be different from person-to-person depending on a number of factors: the strength of the medicine you're using, your body's tolerance to the medicine, the number of dosages you are taking each day, and the longevity of the time which you have to take the medication.

The dosages shown below are standard dosages commonly prescribed by doctors, but they are not intended to replace the dosage outlined by your doctor.

  • For the relief of seasonal allergy symptoms, adults and children aged 2 or more should use one drop per eye, 4 times daily. Children below the age of 2 must have a manageable dosage calculated by the family doctor.
  • For swelling of the eyes following eye surgery, a dosage for adults and children aged at least 2 years old, would be one drop in each affected eye, delivered 4 times daily, beginning 1 day after surgery, and continuing for 2 consecutive weeks following the surgery. Children aged younger than 2 who have had eye surgery, will need to have a proper dosage calculated by the family doctor.
  • For the treatment of burning, stinging, or eye pain after corneal refractive surgery, adults and children aged at least 3 years old, should use 1 drop in each affected eye, 4 times daily, for no more than 4 consecutive days following the surgery. Children aged younger than 3 need to have an appropriate dosage calculated by the family doctor.

If you should miss a dosage of ketorolac, it can be applied to your eyes as soon as you do remember it, unless you don't remember until it's nearly time for your next dose. In that case, just skip the dosage which you missed, and wait until the next scheduled dosage. Do not double up on doses, because it won't provide any more relief for your eyes than your appropriate dosage calls for. You should also never double up on dosages just to get back on schedule.

Interactions

When using ketorolac, there's a possibility that interactions may occur with other drugs that you are taking. If this does happen, it could trigger adverse side effects which you have to deal with, or it may worsen side effects that you are already experiencing. It may also cause a reduction of the effectiveness of either one of the two drugs involved, or both of them.

Since neither one of these scenarios is favorable, it's best to avoid the potential for any kind of drug interactions at all. You can help do this by preparing a list of all medications which you are currently taking, including over-the-counter medications, other prescription drugs, vitamins, and herbal supplements, as well as the dosage levels of each one of these. Your doctor can then review this list and make some kind of determination about the potential for interaction between ketorolac and any of the drugs on your list.

You can also use this list if you have to make an unscheduled trip to the emergency room for treatment, or to any other healthcare clinic where your primary care doctor may not be in residence. In either situation, a doctor can review your medication list, and safely prescribe a program of treatment for you, so that it does not interact with any of the drugs on your list.

You should not start or stop taking any medications without consulting your doctor during the same time frame that you are using ketorolac. This also means you should not modify the dosages of any of these medications.

Some of the drugs most commonly checked for by doctors as having the potential to interact with ketorolac are the following:

  • Any kind of corticosteroid drugs, such as prednisone
  • Any other eye medications
  • Antiplatelet drugs such as clopidogrel
  • Blood thinner drugs such as warfarin, enoxaparin, and dabigatran
  • Pain relievers
  • Fever medications
  • Aspirin
  • Ibuprofen
  • Naproxen

In addition to the possibility of interaction with other drugs, there is a chance that ketorolac will interact with a medical condition you already have. If you have any of the medical conditions on the list below, you should discuss it with your doctor prior to taking ketorolac:

  • Rheumatoid arthritis
  • Eye surgeries
  • Eye surface diseases
  • Corneal epithelial defects
  • Corneal denervation
  • Diabetes
  • Bronchospasm
  • Bleeding problems
  • Asthma
  • Allergy to nonsteroidal anti-inflammatory drugs

Warnings

There are certain precautions or warnings which should be taken into account when using ketorolac. First of all, you should tell your doctor if you are allergic to this medication, or to other nonsteroidal anti-inflammatory drugs such as ibuprofen or celecoxib.

You should also inform your doctor if you have allergies to any other substances, such as pets, fabrics, foods, or preservatives, since your other allergies can be triggered by ingredients in ketorolac.

You should not use this medication if you have a medical history which includes asthma, bleeding problems, prior eye surgeries, dry eye syndrome, corneal problems, nasal polyps, rheumatoid arthritis, or diabetes.

For a period of time after applying this medicine, your vision may be blurry and somewhat unreliable, so it is inadvisable to drive a motor vehicle or operate machinery until your vision clears up, and you feel confident that there are no further hindrances to your vision.

If you are of child-bearing age you should discuss with a doctor whether you are pregnant or plan to become pregnant, during the time you are using ketorolac. To be safe, this medication should not be used while you are pregnant, especially during the first and last trimesters. Patients have experienced problems with the normal labor process, with potential harm to the unborn baby, and even some difficulties with delivery.

It is also known that ketorolac is passed through breastmilk to a nursing infant, and that there is a potential for harm to be caused to the infant, so breastfeeding while you are taking ketorolac is strongly discouraged.

Storage

This medicine should be stored in a closed container, in a room which is kept at normal room temperature, and not subject to any extremes of heat, cold, moisture, or direct lighting. Under no circumstances should it be frozen, since all of these conditions will tend to degrade the effectiveness of the medication, which can reduce its usefulness.

Ketorolac should be kept out of the reach of children in the household, and the cap should always be tightly in place on the bottle, so no accidental ingestion can occur. You should not keep expired ketorolac, nor should it be used if it has exceeded the expiration date.

When you have unused or expired ketorolac, it should not be simply flushed down the toilet or the sink, but should instead be discarded according to proper disposal methods. Your doctor or pharmacist can instruct you about how to properly dispose of any unused medication. If this information is lacking, you can also consult the FDA website on the safe disposal of medicines.

Summary

Ketorolac is an ophthalmic medication which is normally delivered directly into the eye via an eyedropper. It is used for three primary indications: the relief of seasonal allergies, relief of swelling after corneal refractive surgery, and for the relief of swelling after cataract surgery. It is a prescription medication which is sometimes used in tandem with other eye medications, although the two medicines should not be administered to the eyes at the same time.

This drug is in a class of drugs known as non-steroidal anti-inflammatory drugs, and it works by reducing the level of a natural hormone in the body, which causes pain and inflammation, especially around the eyes.